Prevalence of cytomegalovirus antibody in nursing personnel

Hygiene promotion might be better than serological screening to deal with Cytomegalovirus infection during pregnancy: a methodological appraisal and decision analysis

BACKGROUND

Cytomegalovirus infection is the most frequent viral congenital infection, with possible consequences such as deafness, or psychomotor retardation. In 2016, the French High Council of Public Health was mandated to update recommendations regarding prevention of cytomegalovirus infection in pregnant women. We summarize a critical appraisal of knowledge and deterministic decision analysis comparing the current no-screening situation to serological screening during pregnancy, and to hygiene promotion.

METHODS

Screening was defined as systematic serological testing, during the first trimester, with repeated tests as needed, to all pregnant women. Outcomes were: 1) severe sequela: intellectual deficiency with IQ ≤ 50 or hearing impairment < 70 dB or sight impairment (≤ 3/10 at best eye); 2) moderate sequela: any level of intellectual, hearing or sight deficiency; and 3) death or termination of pregnancy. We simulated the one-year course of cytomegalovirus infection in a cohort of 800,000 pregnant women. We developed a deterministic decision model, using best and min-max estimates, extracted from systematic reviews or original studies.

RESULTS

Relevant data were scarce or imprecise. We estimated that 4352 maternal primary infections would result in 1741 foetal infections, and an unknown number of maternal reinfections would result in 1699 foetal infections. There would be 788 cytomegalovirus-related consequences, including 316 foetal deaths or terminations of pregnancy, and 424 moderate and 48 severe sequelae. Screening would result in a 1.66-fold increase of poor outcomes, mostly related to a 2.93-fold increase in deaths and terminations of pregnancy, not compensated by the decrease in severe symptomatic newborns. The promotion of hygiene would result in a 0.75-fold decrease of poor outcomes, related to both a decrease in severe sequelae among symptomatic newborns (RR = 0.75; min-max: 1.00-0.68), and in deaths and terminations of pregnancy (RR = 0.75; min-max: 0.97-0.68).

CONCLUSIONS

Prevention of cytomegalovirus infection during pregnancy should promote hygiene; serological screening should not be recommended.

Prevalence and molecular epidemiology of CMV and EBV among nurses working in pediatrics, transplantology, and primary health care

OBJECTIVE

The aim of the study was to determine and compare the prevalence of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) antibodies and DNA among nurses working in different profiles of healthcare activity.

MATERIAL AND METHODS

The study population comprised 120 women (90 exposed healthcare workers and 30 controls). Blood samples were investigated using chemiluminescent microparticle immunoassays (CMIA) tests to detect the presence of EBV VCA IgM, IgG, and CMV IgM, IgG. Plasma CMV and EBV DNA levels were assessed using real-time polymerase chain reaction (PCR).

RESULTS

CMV IgG antibodies were present in 87.80% nurses (86.70% in controls), EBV IgG were present in all the nurses studied and in the control group. No statistically significant differences were noted between the subgroups of nurses and the control group as regards IgG CMV, VCA IgG EBV. CMV IgM/EBV IgM antibodies were negative in all the nurses. CMV/EBV DNA was reported only in the study group. It was not found in any of control group participants.

CONCLUSIONS

The positive PCR CMV/EBV markers only in the study group can be indicative of the exposure of nurses to these pathogens being greater than in other people not being professionally involved in patient care. In addition, it was observed that the level of CMV IgG antibodies as well as EBV VCA IgG antibodies tended to be linked to the age and the length of work of nurses working in pediatrics.

Cytomegalovirus seroprevalence in exposed and unexposed populations of hospital employees

The objective of this work was to compare the seroprevalence of cytomegalovirus in an unexposed and exposed population, both working in a hospital, and to study the occupational risk factors related to seropositivity, while taking personal risk factors into account. We conducted a cross-sectional study in a French hospital over a period of 12 months. The overall seroprevalence among the 550 subjects was 49.5%. The multivariate analysis showed that seropositivity was significantly associated with age (36-43 years: odds ratio [OR] = 1.7; 95% confidence interval [CI]: [1.1-2.8]) and working as a pediatric nurse's aide (OR = 1.8; 95% CI: [1.1-2.8]). This study confirms the need to improve prevention procedures in the workplace, including screening, information, and hygiene rules.

The febrile father with a cytomegalovirus infection. A family affair

Existing evidence has convincingly established that young children often transmit cytomegalovirus (CMV) infection to their parents. What proportion of these parental infections lead to clinical disease is unknown, but this sequence of events is probably not rare. Physicians seeing young adults with prolonged but otherwise nondescript febrile illness should inquire about the presence of young children in the household. Parental CMV infection is not limited to parents whose children attend day-care centers or are cared for in neonatal intensive care units. As in our case of the febrile father, it may be strictly a family affair.

Cytomegalovirus infection in pediatric house officers: susceptibility to and rate of primary infection

Hospital personnel, especially women in their child-bearing years, continue to express concern about the risk of acquiring cytomegalovirus (CMV) infection as a result of their occupation. Previous investigations of occupational risk of CMV infection have focused primarily on pediatric nursing personnel. However, assessment of the rate of CMV infection by other hospital personnel who have different clinical responsibilities and levels of patient contact cannot rely solely on the rates obtained for nursing personnel.

Cytomegalovirus: epidemiology and infection control

Cytomegalovirus (CMV) causes asymptomatic infection in most individuals but can produce devastating illness in immunocompromised hosts and in a small proportion of congenitally infected babies. New techniques in molecular biology have provided insights into the epidemiology and transmission of CMV. Children in day care, their parents, and sexually active individuals, especially homosexual men, are now known to be at particular risk for acquiring CMV. Recent studies show that the risk of CMV acquisition by health care workers is similar to the risk to the general public. Health care workers should be aware of the wide range of clinical manifestations, methods of laboratory diagnosis, and current limitations of treatment of CMV. Careful handwashing and avoidance of excretions and secretions are recommended to decrease the transmission of CMV in the hospital.

Is primary cytomegalovirus infection an occupational hazard for obstetric nurses? A serological study

The results are reported of a 4-year prospective study of the incidence of primary cytomegalovirus (CMV) infection in the nursing staff of a specialist obstetric hospital. The absence of seroconversion found in personnel attending patients with confirmed CMV-infection justifies reassuring staff members in "high-risk" areas of the adequacy of the methods used to combat cross-infection. On the other hand, a low rate of seroconversion (1.2% per annum) in the staff who nurse normal mothers and "rooming-in" babies emphasizes the need for the rigorous observance of hygienic precautions by all personnel in all areas. The results of this Australian investigation are discussed in relation to the northern hemisphere experience of CMV-seroconversion in pediatric nurses.